Climate Justice Prescription: Whatever You Do, It Will Have an Impact

I’m a physician in internal medicine at the University of Minnesota. I also belong to Health Professionals for a Healthy Climate—a group of over 400 Minnesotan health professionals working to protect the health of Minnesotans from climate change. I would like to discuss how climate change impacts some people more than others. Before I do that, I want to acknowledge my privilege as a physician. I have the means to choose where I live, I have the knowledge necessary to protect myself from climate-health impacts, and I have access to healthcare. But that is not the case with many of the patients I see, and certainly not the case with many people in India where I’m from.

When we say climate change impacts health, what do we really mean? Allow me to share a story that’s a composite of several stories of patients for whom I’ve provided care. I’ve changed their names and demographics for privacy. I’ll talk first about a six-year-old. Let’s call her Sarah. She lives in the inner city and she has asthma. Her mom has to work two jobs to pay for Sarah’s medicines and school, their groceries, rent, and so on. Sarah plays outside in the summer, largely because they want to save money on electricity. But summer air isn’t good for her because during hot summers the air stagnates, and pollutants released from cars and buildings all bake together in sunlight and form ground-level ozone.

Now, we all know about the ozone layer that’s supposed to protect us. When ozone is at the ground level, it’s bad for our health and can trigger asthma attacks. So, Sarah now gets an asthma attack and her mom has to take time off work to take her to the emergency room. This is the fifth time Sarah has gone to the ER this year; her mom’s boss isn’t happy with her taking another day off and thinks maybe she should find another job.

Sarah comes into the hospital. As she receives treatment with inhalers, she feels better and luckily doesn’t have to be admitted. But now her mom is stuck with a huge bill. She has to decide whether she wants to pay the bill or pay their rent. Not paying the rent puts them closer to eviction.

This is not a fictional story; this is something I see my patients go through daily—the challenges of trying to afford their medications and distributing that money in the rest of their lives. In fact, a survey of those who received energy bill assistance at least once in five years showed that about a third of the households could not afford to fill a prescription to full dose, and about one in five households had someone become sick because their home was too cold. These problems are compounded by many social justice issues including lack of access to affordable healthcare, low wages, and systemic racism in medicine and housing practices, which demonstrates that climate injustice does not exist in isolation. Today, four out of ten Americans live in areas with air pollution levels that are unhealthy. African Americans are exposed to 40 percent more polluted air compared to their white counterparts. African Americans are seventy-five percent more likely to live in fence-line communities (neighborhoods right next to fossil fuel infrastructure) than the average American. Since the 1970s, after the Clean Air Act was passed, our air quality has improved, but climate change is now cutting into those gains and increasing the number of high-ozone days—the climate penalty.

Now let’s take a trip to India to meet another six-year-old. She lives in a village just outside New Delhi. She lives in a hut where her mother uses an open cook stove. Because the child is a girl, she’s not allowed to go to school, so she spends most of her time in the house breathing in the smoke from the cook stove. There’s also a great deal of outdoor air pollution, all of which puts her at risk for getting pneumonia. And in her village, climate change is resulting in drought, which means her family doesn’t have access to enough food and she’s very malnourished. When she does get pneumonia, her family doesn’t have the money to take her to a doctor, and with no hospital close by, she dies.

Seven million people each year around the world die prematurely from air pollution and one-third of the burden is in Southeast Asia. Again, there are so many issues at play here and climate change is not the only one—issues of gender inequality, food insecurity, and lack of access to healthcare are also involved.

Heat is another effect of climate change that impacts health. Urban heat island effects are especially prominent in the city vs. rural areas. The people most vulnerable to heat exposure are young children who play outside, construction workers, the elderly, and people who aren’t able to go inside, including the homeless population. In the United States, 24 million more Americans were exposed to extreme heat in 2011 and 12.3 million more in 2016 when compared to 2000, exposing them to health effects including potentially lethal heat stroke. The impacts are a lot more severe in countries like India and Pakistan. In Pakistan in 2015, for example, many children and older people were among the 2,000 who died in a heat wave that saw temperatures as high as 120 degrees. With limited access to heat warning systems and adaptation measures like air-conditioning, heat waves result in more fatalities in low-resource settings.

Another way climate change affects health is in the form of extreme weather events, specifically hurricanes. The first deaths from hurricanes happen from drowning, injury, or electrocution. Once the storm passes, especially in a case like Hurricane Maria in Puerto Rico where the entire island’s infrastructure was destroyed, people have no access to healthcare. Many roads were washed away in that 2017 disaster, If someone had a heart attack they couldn’t get to a hospital. Likewise, people with kidney failure who needed dialysis were unable to receive it, as the procedure depends upon electricity and clean water. There was also a lack of access to clean drinking water resulting in many water-borne infections.

In the case of Maria, for a death to be certified the body had to be taken to San Juan to a medical officer. That’s not a priority when you lose your home and your loved ones, and you have no access to food, electricity, or safe drinking water. So, in the aftermath, researchers who were trying to determine the death toll of the Hurricane went door to door and spoke with the residents about the loved ones they lost. Because it took so long for the infrastructure and services to return to baseline, the death toll kept rising. I particularly remember the coverage around Maria being very similar to how we talk about disasters in developing countries. It is framed as the fault of the effected; those people didn’t have good systems to begin with and that’s why they faced such massive, adverse effects was a commonly expressed sentiment.

Last March, intense Tropical Cyclone Idai hit Mozambique. What’s unnerving with this hurricane is the damages they sustained despite planning for it. As Daviz Simango, mayor of Beira, explained in an NPR interview, they knew that climate change was going to cause more severe storms in their area, so they had storm water systems set up to tackle flooding and wave barriers. What they didn’t plan for were the high winds that resulted in so much infrastructure loss. This was a stark reminder that we need to continue to learn and develop new ways to adapt to climate change. This also shows that the so-called developed countries can learn from developing countries when it comes to climate adaptation. In many parts of the world, you don’t have the luxury to deny climate change because you’re already suffering the impacts.

In India, for example, this May Cyclone Fani hit Orissa—one of the poorest states in the country. But the hurricane warning systems and evacuation measures were remarkably successful, which meant a minimal death toll. This is why I do not like the word “vulnerable” to describe people who face the worst of climate impacts. It generates a certain sense of pity, can put the burden on the people suffering the impacts, and doesn’t talk about the many social injustices that created these inequalities—for example, on a global scale from centuries of colonization and exploitation for resources.

Data from the Poor People’s Campaign shows that as household income goes up, the amount of greenhouse gases produced goes up as well. And people with low income suffer the impacts of climate change more. A study published in March by the Proceedings of the National Academy of Sciences found that African Americans experience 56 percent more air pollution than they’re responsible for producing; Hispanic communities experience 63 percent more than they produce; and Caucasians experience 17 percent less pollution than they produce. On a global scale, the top 10 percent of the richest countries produce almost 50 percent of the world’s greenhouse gases, while the poorest 50 percent contribute only 10 percent. Since the Trump administration came into power, over seventy-eight environmental regulations have been rolled back. By definition every time you weaken environmental regulations, some people will be impacted more than others.

It took me some time to figure out my place in the environmental movement. I thought, I’m not a climate scientist or a policy expert. What do I know? So I went to the community that was already working on an environmental justice issue and asked how my skillset as a doctor could help. That is when I understood that I could use my scientific knowledge to push for climate policies that would also protect our health. While I was working at the Johns Hopkins Bayview Medical Center in Baltimore, I testified for the Maryland Department of Environment on the environmental justice aspects of a local incinerator. Another issue I worked on was restricting oil trains. There are efforts around the country to limit oil transport through pipelines. The oil companies then transport oil via train tankers. The hospital I was working at was right next to the railroad tracks for one of these oil trains. I worked on a campaign to pass landmark climate legislation to limit crude oil trains passing through the city of Baltimore. In Minnesota, I’m now working on policies for renewable energy, clean electric transportation, and limiting the spread of fossil fuel infrastructure including pipeline 3, which is an Enbridge pipeline that proposes to bring 760,000 barrels of crude oil from Alberta, Canada, to Superior, Wisconsin, via Minnesota.

So, how do we work towards climate justice? As we’ve seen, climate change never impacts people in isolation. It is a “threat multiplier” in the framework of societal injustices like systemic racism, gender inequality, and marginalization of low-income families. This can seem very overwhelming, but there’s also another way to look at it. Not all of us have the calling to work on climate or climate justice issues. But the key is recognizing that no matter how you intervene, if you are working to right a societal wrong, you will bring us closer to climate justice.

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